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You find yourself straining to hear a conversation in a crowded restaurant. Or, loved ones complain that you have the TV on too loud. You frequently ask people to repeat themselves.

All of these are possible early signs of hearing loss. Although hearing loss can begin at any age, it’s more common in older people.

Here’s what you need to know about hearing loss, and how to look for symptoms of hearing impairment.

What Are the Symptoms of Hearing Loss?

Hearing loss symptoms tend to appear gradually, especially as you age. You or your loved ones might notice subtle shifts in your hearing.

There are many early warning signs of hearing loss. You may:

• Ask people to repeat themselves.
• Find it hard to follow a conversation when more than two people are talking.
• Find you can’t follow conversations in spaces with a lot of background noise, like at a party or restaurant.
• Have trouble hearing high-pitched sounds, like birds chirping or children talking.
• Have difficulty understanding people over the phone.
• Notice your ears feel clogged or muffled.
• Think that people mumble when they talk.
• Turn up the TV volume higher than other people.

What Are the Stages of Hearing Loss?

Doctors divide hearing loss into categories based on the softest sound you can hear. They measure loudness in decibels (dB). For someone with mild hearing loss, a sound must reach 26 to 40 dB to hear it.

The stages of hearing loss are:

• Mild (26 to 40 dB) — You may have trouble hearing people speaking quietly. Softer consonant sounds, such as S, F, and H, are often difficult to distinguish.
• Moderate (41 to 55 dB) — You miss consonant sounds, and vowel sounds become muddy.
• Moderate-severe (56 to 70 dB) — You can’t hear well without hearing aids. You may begin to rely on lipreading.
• Severe (71 to 90 dB) — You can’t hear speech without hearing aids or cochlear implants.
• Profound (91+ dB) — Without hearing aids or implants, you may only hear very loud sounds like a fire alarm. You may rely on sign language or other visual cues to communicate.

What Causes Hearing Loss?

You may start to lose your hearing for many different possible reasons.

Aging

Simply getting older is the most common reason people have hearing loss. Age-related hearing loss usually affects both ears.

About one-third of people over 65 have some hearing loss, and half of those over 85 have hearing loss. That’s because the nerve cells in the ears naturally wear out over time. They don’t send the electrical signals necessary for good hearing to the brain.

Health conditions like high blood pressure and diabetes — both common in older adults — can also contribute to hearing loss.

Disease

A tumor called an acoustic neuroma can cause ringing (tinnitus) or a feeling of fullness in your ear. Meniere’s disease causes dizziness and tinnitus, along with hearing loss that comes and goes. Other diseases that can cause hearing loss are otosclerosis and autoimmune inner ear disease.

Earwax

Although earwax is natural, earwax buildup in your ear canal can block sounds from moving through it. Your doctor can remove earwax during an office visit, and after treatment, your normal hearing should return.

Genetics

Some babies have hearing problems at birth or develop them later in childhood.

There is also a possible genetic component to hearing loss in older people. Many people with age-related hearing loss have relatives with hearing problems. But because hearing loss is so common in older people, it’s hard to say how much family history plays a part.

Injury

Traumatic injury to the brain or damage to the middle ear can cause sudden hearing loss. This could result from a skull fracture or trauma from explosions, fireworks, or gunfire.

A ruptured eardrum can also cause hearing loss. Your eardrum can burst from changes in pressure (like from scuba diving) or getting punctured with a sharp object. An untreated ear infection can also cause your eardrum to burst.

Loud noise

Hearing loss can also stem from sustained noise over a long period of time. This could result from power tools, industrial noise, or leaf blowers. Loud music can cause ear damage, especially with earbuds or headphones.

What Do I Do If I’m Losing My Hearing?

If you have signs of hearing damage, you shouldn’t ignore them. Hearing loss can affect your daily life in many ways, from relationships to employment. When you have trouble communicating, it can contribute to isolation and depression and even make you more likely to develop dementia.

You should see a specialist if you notice signs of hearing loss, even subtle ones. An audiologist is a doctor who specializes in treating hearing problems.

It’s also important to let family and friends know you have a hearing problem. It’s OK to:

• Ask people to face you when talking and speak loudly and clearly.
• Let people know if you don’t understand them.
• Look for a quieter place to talk if you’re in a noisy, crowded space.
• Pay attention to body language, gestures, and facial expressions.

Can You Restore Your Hearing?

You may prevent some types of hearing problems, but you can’t fully restore hearing loss. However, many treatment options can help you hear better. They include:

• Over-the-counter (OTC) hearing aids — A good possible option for mild to moderate hearing loss. They make sounds louder so you can hear them better.
• Prescription hearing aids — For moderate to severe hearing loss. Your doctor will provide regular adjustments and support going forward.
• Surgery for cochlear implants — These devices can help people with severe or profound hearing loss. They create electrical signals that the brain recognizes as sound. Cochlear implants need surgical placement and subsequent hearing therapy.
• Technology — More high-tech options than ever can help with hearing loss. Captions, speech-to-text apps, and vibrating alert systems can help you communicate.

What Do I Do If I Have Sudden Hearing Loss?

Losing your hearing suddenly can indicate an infection, injury, or even a stroke. Sudden hearing loss can happen in one or both ears.

You should seek medical help right away if you experience:

• Dizziness.
• Drainage from one or both ears.
• Headaches, weakness, or numbness anywhere in your body.
• Sudden ear pain.
• Sudden hearing loss, especially if it’s only in one ear.
• Sudden ringing (tinnitus) in your ears.